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<title>register</title>
<link type="text/css" rel="stylesheet" href="../css/user/register.css" />

<script type="text/javascript" src="../js/formValidator-4.0.1.js"></script>
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<body >

<div id="reg_title"><img src="../pic/icon4.gif" /><h2>非会员用户请输入个人详细信息</h2></div>
<div class="reg_info"><p>以下为必填项</p></div>
<div id="reg_table">
<form id="registerForm" method="post" name="registerForm" action="/user/regactivate">
<div id="table_up">

<table>
	<tbody>
		<tr>
			<td class="left" valign="middle" >用户名：</td>
			<td width="372" class="right_one">
			<div class="right_one_input"><input type="text" id="username" class="right_input"
				name="username" maxlength="50" /><dfn class="dfn">*</dfn></div>
			
			</td>
			<td><div id="usernameTip" style="width:180px;"></div></td>
			
		</tr>
		
		<tr>
			<td class="left" valign="middle">密码：</td>
			<td>
			<div class="right_one"><input type="password" id="pass" name="pass" class="right_input"
				maxlength="50" /><dfn class="dfn">*</dfn></div>
			
			</td>
			<td><div id="passTip"></div></td>
		</tr>
		<tr>
			<td valign="middle" class="left">再次输入密码：</td>
			<td>
			<div class="right_one"><input type="password" id="config_password"  class="right_input"
				name="config_password" maxlength="50" /><dfn class="dfn">*</dfn></div>
			
			</td>
			<td><div id="config_passwordTip"></div></td>
		</tr>
		<tr>
			<td valign="middle" class="left">E-mail：</td>
			<td>
			<div class="right_one"><input type="text" maxlength="100" id="email" 
				name="email" class="right_input" /><dfn class="dfn">*</dfn></div>
			
			</td>
			<td><div id="emailTip"></div></td>
		</tr>
        <tr>
		<td class="left" valign="middle" width="150px;">身份证号：</td>
		<td class="right_one">
		<div class="right_one_input"><input type="text" id="id" name="id" class="right_input"
			maxlength="50" /><dfn class="dfn">*</dfn></div>
		
		</td>
		<td>
        <div id="idTip"></div></td>
	</tr>
	<tr>
		<td class="left" valign="middle" width="150px;">
        手机号：</td>
		<td class="right_one">
		<div class="right_one_input"><input type="text" id="telephone" class="right_input"
			name="telephone" maxlength="50" /><dfn class="dfn">*</dfn></div>
		
		</td>
		<td><div id="telephoneTip" ></div></td>
	</tr>
   
	</tbody>
    
</table>
</div>
<div id="table_line"></div>

<div class="reg_info"><p>以下为非必填项</p></div>
<div id="table_down">
<table>
<tbody>
<tr>
		<td class="left" valign="middle" width="150px;">
        患者性别：</td>
		<td class="right_one">
		<div class="right_one_input"><input type="radio" name="sex" class="sex" value="1"  />男<input type="radio" name="sex" class="sex" value="2" />女</div>
		
		</td>
		
	</tr>
<tr>
		<td class="left" valign="middle" width="150px;">
        家庭住址：</td>
		<td class="right_one">
		<div class="right_one_input"><textarea name="address" id="address"></textarea></div>
		</td>
	</tr>
    
	</tbody>
</table>

</div>
<div id="submit"><input type="submit" value="提交" name="submit" class="button" style="margin-right:30px" /><input type="button" name="button" value="返回" class="button" onclick="window.location.href='/index/index'"/></div>
</form>
</div>





</body>
</html>
